Depressed youth, suicidality and antidepressants

No cause for panic, but an incentive to improve clinical practice

The use of selective serotonin reuptake inhibitors (SSRIs) in depressed children and adolescents has received consider-able attention in the past year; this attention has included concerns about increased suicide risk, revised evidence about effectiveness, growing prescription numbers, and revelations of drug companies withholding data.1 The discovery of unforeseen risks in other drugs such as cyclooxygenase-2 inhibitors has intensified the climate of uncertainty and mistrust about drug treatment. Some argue that to diagnose major depression in children is to medicalise the unhappiness caused by affluence, permissiveness, a decaying family and society.2 By contrast, medical practitioners and governments have been told during the last quarter century that depression is a serious illness that can lead to suicide, poor physical health, and personal, professional and social difficulties. Thus, the Australian community has invested considerable resources in trying to tackle this scourge (eg, The National Depression Initiative3). If experts disagree, it is little wonder that the public and clinicians are confused, yet severely depressed teenagers continue to come to doctors for management.